| NPI | 1770153934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002773) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPCC.0023180) |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2026-04-10 |