| NPI | 1871517243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 880-124) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MA 6390) |
| 101YP2500X Counselor Professional (Licence: WI 4633-125) | |
| 106H00000X Marriage & Family Therapist (Licence: PA MF000622) | |
| 106H00000X Marriage & Family Therapist (Licence: NJ 37FI00162200) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2023-02-22 |