| NPI | 1518213727 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: PA 1141) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 88211) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2025-01-02 |