| NPI | 1619313988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IL 166.001334) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KY 104021) |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2024-08-27 |