| NPI | 1194350017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY 002211) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA MFT001920) |
| Enumeration Date | 2020-03-11 |
| Last Update Date | 2025-01-27 |