| NPI | 1275853293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY 000804) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2018-05-11 |