| NPI | 1831883271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002578) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2024-08-28 |