| NPI | 1871745117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO 980) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 5696849-3902) |
| Enumeration Date | 2008-10-17 |
| Last Update Date | 2023-11-17 |