| NPI | 1346600871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO LPC.0013162) |
| Additional Taxonomies | 103TE1100X Psychologist Exercise & Sports |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2016-02-25 |
| Last Update Date | 2025-07-21 |