| NPI | 1467188383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0021323) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MFTC.0014343) |
| Enumeration Date | 2022-07-25 |
| Last Update Date | 2025-02-12 |