| NPI | 1609154525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NM 0171901) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NY 1261) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2019-10-08 |