| NPI | 1114134087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 834-124) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 102-228) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2011-01-19 |