| NPI | 1194364372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: PA MF001763) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 105600) |
| Enumeration Date | 2020-01-05 |
| Last Update Date | 2026-05-21 |