| NPI | 1790305431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0023939) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACB.0008568) |
| 101YM0800X Counselor, Mental Health (Licence: CO ACD.0002680) | |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2026-06-26 |