| NPI | 1821114133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO LPC-5587) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2010-04-07 |