| NPI | 1043596505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY 000664) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 003280) |
| 101YP2500X Counselor, Professional (Licence: NY 37PC00042800) | |
| Enumeration Date | 2011-10-28 |
| Last Update Date | 2020-09-17 |