| NPI | 1124251889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO 1061) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 13699) |
| 101YM0800X Counselor, Mental Health (Licence: NE 8966) | |
| Enumeration Date | 2009-08-28 |
| Last Update Date | 2023-01-23 |