| NPI | 1679109375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CO LPC.0001171) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WY LPC-647) |
| 106H00000X Marriage & Family Therapist (Licence: CO MFT.0001666) | |
| 106H00000X Marriage & Family Therapist (Licence: WY LMFT-088) | |
| Enumeration Date | 2020-03-14 |
| Last Update Date | 2020-03-14 |