| NPI | 1831452374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 5731) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 492) |
| 101YP2500X Counselor, Professional (Licence: CO 1570) | |
| 106H00000X Marriage & Family Therapist (Licence: CO 804) | |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CO 116891) | |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2023-01-25 |