| NPI | 1407955818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 147357) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 61124) |
| 106H00000X Marriage & Family Therapist (Licence: IL 166000461) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2021-10-14 |