| NPI | 1912389750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0000469) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0011890) |
| Enumeration Date | 2015-06-28 |
| Last Update Date | 2017-07-31 |