| NPI | 1750826780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0016413) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 0001279) |
| Enumeration Date | 2016-12-29 |
| Last Update Date | 2024-09-16 |