| NPI | 1821687054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD00001395) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC0016601) |
| Enumeration Date | 2021-01-12 |
| Last Update Date | 2021-01-12 |