| NPI | 1417222134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO 1317) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 106H00000X Marriage & Family Therapist (Licence: TN 1244) | |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2016-06-16 |