| NPI | 1245347053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO 514) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CO 275) |
| 106H00000X Marriage & Family Therapist (Licence: WY 157) | |
| 106H00000X Marriage & Family Therapist (Licence: WA LF61180612) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2021-08-25 |