| NPI | 1831431337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD0000346) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC0012761) |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2016-02-19 |