| NPI | 1770897019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0011425) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO 11425) |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2024-05-31 |