| NPI | 1033202387 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 000067) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 001165) |
| 106H00000X Marriage & Family Therapist (Licence: NY 000006) | |
| Enumeration Date | 2006-10-01 |
| Last Update Date | 2007-07-08 |