| NPI | 1538584560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 1033) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 2840) |
| Enumeration Date | 2014-02-27 |
| Last Update Date | 2018-11-16 |