| NPI | 1932403243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09924898) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NV 101Y0000X) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 0007724) | |
| 101YM0800X Counselor, Mental Health | |
| 104100000X Social Worker | |
| Enumeration Date | 2010-12-29 |
| Last Update Date | 2018-05-17 |