| NPI | 1467610881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 1797) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401007845) |
| 106H00000X Marriage & Family Therapist (Licence: CO 469) | |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2023-02-03 |