| NPI | 1679585707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY 06 000512) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 18 002810) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2007-08-22 |