NPI | 1316135064 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO MFT0001105) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACC 0020817) |
Enumeration Date | 2007-10-09 |
Last Update Date | 2014-04-24 |