| NPI | 1285997577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 1018-124) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 2628) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2024-03-14 |