| NPI | 1629300728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY 06 001014) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2010-02-01 |
| Last Update Date | 2015-01-16 |