| NPI | 1730371022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO MFT.0002973) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002464) |
| 101YM0800X Counselor, Mental Health (Licence: CO LPC.0021523) | |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2025-11-24 |