| NPI | 1609959006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 723) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 1130) |
| 106H00000X Marriage & Family Therapist (Licence: NH 203) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2016-08-30 |