| NPI | 1871945915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0000796) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0014132) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2019-04-09 |