| NPI | 1861600439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 187) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO 394) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2010-07-19 |