| NPI | 1902073448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0001138) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0015102) |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0015102) | |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2019-06-18 |