| NPI | 1053754291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY 000525) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2013-04-08 |