NPI | 1992043988 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0015082) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO 13426) |
Enumeration Date | 2013-01-25 |
Last Update Date | 2021-05-10 |