| NPI | 1457632218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC-5584) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO MFT.0002364) |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0019370) | |
| 106H00000X Marriage & Family Therapist (Licence: MT BBH-LMFT-LIC-48138) | |
| 106H00000X Marriage & Family Therapist (Licence: ID LMFT-5534) | |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2024-09-26 |