| NPI | 1265242648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0022808) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO MFTC.0014749) |
| Enumeration Date | 2025-01-08 |
| Last Update Date | 2025-01-08 |