| NPI | 1639727241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IA 111007) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IL 166001554) |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2026-04-03 |