| NPI | 1982987368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 74124) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 393-123) |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2011-09-22 |