| NPI | 1366565913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 005266) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 86401) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2018-09-04 |