| NPI | 1215642988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY 001344) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OH F.2100222) |
| Enumeration Date | 2023-01-17 |
| Last Update Date | 2023-01-17 |