| NPI | 1659679199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACC-7098) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO csw-1229) |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2011-03-08 |