| NPI | 1548708464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 3322) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 2039-124) |
| Enumeration Date | 2017-02-11 |
| Last Update Date | 2024-09-09 |