| NPI | 1386778561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY 001090) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 47612) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2019-12-10 |