| NPI | 1801029772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 949-124) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 1889) |
| 106H00000X Marriage & Family Therapist (Licence: IL 166.001089) | |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2022-07-21 |