| NPI | 1861613465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY 196968) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NY 000384-1) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2011-04-06 |