| NPI | 1659837474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CO CSW.09929667) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CO ACD.0002322) |
| Enumeration Date | 2019-02-17 |
| Last Update Date | 2023-10-09 |