| NPI | 1114250594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY 001313) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 85401) |
| Enumeration Date | 2009-09-16 |
| Last Update Date | 2016-05-31 |