| NPI | 1295262004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0017452) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO NLC.0104825) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2022-06-06 |