| NPI | 1295792257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY 06000343) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301011936) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2019-02-26 |