| NPI | 1265607840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: DE FT0000054) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: PA MF000721) |
| 106H00000X Marriage & Family Therapist (Licence: WI 850-124) | |
| 106H00000X Marriage & Family Therapist (Licence: NJ 37FI00162100) | |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2019-08-29 |