| NPI | 1801174511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY 000565-1) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 003360-1) |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2011-07-29 |