| NPI | 1619062791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO 954) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: RI MFT00071) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2012-02-24 |