| NPI | 1710753462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPCC.0020860) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ADDC.0000422) |
| Enumeration Date | 2023-12-04 |
| Last Update Date | 2023-12-04 |