| NPI | 1982785325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 599) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 70787) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO CAC 6242) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2024-05-14 |