| NPI | 1912092545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: PA MF000617) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC35609) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2011-11-23 |