| NPI | 1073683504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO PSY1718) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFT016551) |
| 106H00000X Marriage & Family Therapist (Licence: CO MFT092) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2007-07-08 |