| NPI | 1912486861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002835) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0022096) |
| Enumeration Date | 2018-08-11 |
| Last Update Date | 2025-10-27 |