| NPI | 1497161061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ME MF5110) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NY 001228-1) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2019-11-27 |