| NPI | 1649638602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CO 675) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO 045) |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2016-02-05 |