| NPI | 1386191567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0001450) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACC.0006225) |
| 106H00000X Marriage & Family Therapist (Licence: CO MFT.0000650) | |
| Enumeration Date | 2016-09-06 |
| Last Update Date | 2016-09-06 |