| NPI | 1306129325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO MFT.0001250) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2015-08-25 |