| NPI | 1255099792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO MFTC.0014501) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0020882) |
| Enumeration Date | 2021-12-01 |
| Last Update Date | 2024-02-14 |