| NPI | 1811154321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO 0001268) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WY LMFT 134) |
| 106H00000X Marriage & Family Therapist (Licence: UT 8971102-3902) | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2021-01-18 |