NPI | 1710029210 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY 000035) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R047940) |
1041C0700X Social Worker, Clinical (Licence: CT 004362) | |
106H00000X Marriage & Family Therapist (Licence: CT 000546) | |
Enumeration Date | 2007-02-12 |
Last Update Date | 2025-09-11 |