| NPI | 1902312788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0016020) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0001310) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2017-12-16 |
| Last Update Date | 2023-11-09 |