| NPI | 1023595964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY 001763-01) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MA 1702) |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2023-07-24 |