| NPI | 1548349848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 650-124) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 913) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2007-07-08 |