| NPI | 1720369192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO 1270) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: CO 11368) | |
| Enumeration Date | 2011-08-30 |
| Last Update Date | 2022-02-23 |