| NPI | 1851740625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0000611) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPCC.0014605) |
| Enumeration Date | 2016-06-12 |
| Last Update Date | 2016-06-12 |