| NPI | 1710029210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R047940) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 004362) |
| 106H00000X Marriage & Family Therapist (Licence: CT 000546) | |
| 106H00000X Marriage & Family Therapist (Licence: NY 000035) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2007-07-09 |