| NPI | 1689030850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC0012216) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACB0007904) |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2016-01-04 |