| NPI | 1023198116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 665-125) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 2910-123) |
| 106H00000X Marriage & Family Therapist (Licence: WI 29-124) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2007-07-08 |