| NPI | 1154654895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO 1204) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 6156) |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2016-10-05 |