| NPI | 1912232612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO 0001236) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 829-124) |
| Enumeration Date | 2009-10-14 |
| Last Update Date | 2015-09-15 |