| NPI | 1770959843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0013544) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0001201) |
| 172A00000X Driver | |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2025-03-13 |