| NPI | 1053180828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO MFT.0003028) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0021800) |
| Enumeration Date | 2023-12-21 |
| Last Update Date | 2025-12-16 |