| NPI | 1609168053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WY LMFT-168) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MT SWP-LMFT-LIC-4524) |
| 101YP2500X Counselor, Professional (Licence: MT SWP-LCPC-LIC-4541) | |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2013-06-06 |