| NPI | 1164895751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO MFTC.0013459) |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2020-08-19 |