| NPI | 1770113060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 09929352) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 2221) |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2020-01-25 |
| Last Update Date | 2023-06-08 |