NPI | 1285273318 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO MFTC.0014400) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002505) |
Enumeration Date | 2020-01-06 |
Last Update Date | 2024-10-21 |