| NPI | 1962033522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY 001630) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 139884) |
| Enumeration Date | 2020-01-31 |
| Last Update Date | 2023-09-28 |