| NPI | 1770817025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 101YP1600X Counselor, Pastoral | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC1900X Psychologist, Counseling | |
| 103TF0200X Psychologist, Forensic (Licence: CO NLC448 DOC Approved) | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2009-09-18 |
| Last Update Date | 2009-09-18 |