| NPI | 1386411031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO MFT.0002861) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO ACD.0002349) |
| Enumeration Date | 2023-12-04 |
| Last Update Date | 2025-04-15 |