NPI | 1881733087 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY 000221-1) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 003149) |
101YM0800X Counselor, Mental Health (Licence: NY 003149-1) | |
Enumeration Date | 2007-02-05 |
Last Update Date | 2011-05-31 |