| NPI | 1720678329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002036) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0017891) |
| 101YM0800X Counselor, Mental Health | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YP2500X Counselor, Professional (Licence: CO 0017321) | |
| Enumeration Date | 2021-01-19 |
| Last Update Date | 2023-02-28 |