| NPI | 1861802498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO MFT.0001333) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CO NLC.0103614) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2021-06-11 |