| NPI | 1508330770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO 14278) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 8919610-3904) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2019-01-21 |
| Last Update Date | 2023-02-28 |