| NPI | 1730696493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 101YS0200X Counselor, School | |
| 106H00000X Marriage & Family Therapist (Licence: CO 0013931) | |
| Enumeration Date | 2018-01-03 |
| Last Update Date | 2023-08-02 |