| NPI | 1770072811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 4707) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 992263) |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2025-03-03 |