| NPI | 1942482328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 4697) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO 1263) |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2021-02-03 |