| NPI | 1457572984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 1026-124) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101006221) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2015-07-23 |