| NPI | 1265540025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 890) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 604 124) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2007-07-09 |