| NPI | 1588713168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WI 1683-125) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 420-124) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2007-07-08 |