| NPI | 1275936486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 711-228) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 174H00000X Health Educator | |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2024-03-08 |