| NPI | 1770670796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NY 001008) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NY 000237) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2007-07-08 |