| NPI | 1326172933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 4868) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 4868) |
| 106H00000X Marriage & Family Therapist (Licence: CO 4868) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2015-06-24 |