| NPI | 1992656664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO STU-13229) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2026-02-06 |
| Last Update Date | 2026-07-28 |