| NPI | 1669194122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO MFT.0002785) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002447) |
| 106H00000X Marriage & Family Therapist (Licence: CO MFT.0002785) | |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2026-01-27 |