| NPI | 1134547573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IL 166.000952) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 53934) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2014-04-02 |