| NPI | 1740502533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO Mft.0001241) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MA 1396) |
| 106H00000X Marriage & Family Therapist (Licence: AZ LMFT10416) | |
| Enumeration Date | 2010-02-19 |
| Last Update Date | 2022-11-29 |