| NPI | 1508004730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO 793) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 4661) |
| Enumeration Date | 2009-01-26 |
| Last Update Date | 2009-01-26 |