| NPI | 1366817181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 1017-124) |
| Additional Taxonomies | 251S00000X (Licence: WI 1017-124) |
| Enumeration Date | 2015-12-04 |
| Last Update Date | 2023-03-14 |