| NPI | 1942995329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002657) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO SWC.0000001453) |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2025-01-07 |