| NPI | 1639301708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO 5441) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO 1141) |
| 106H00000X Marriage & Family Therapist (Licence: CO 1139) | |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2021-09-21 |