| NPI | 1083795983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 129353) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 2337) |
| 106H00000X Marriage & Family Therapist (Licence: NY 136) | |
| 106H00000X Marriage & Family Therapist (Licence: VT 0073062) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2023-01-11 |