| NPI | 1528310927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 289-228) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 1539-226) |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2012-10-09 |