| NPI | 1073094694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO MFTC.0013954) |
| Enumeration Date | 2018-08-22 |
| Last Update Date | 2020-05-18 |