| NPI | 1629149232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY 000014) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 000051) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2007-07-10 |