| NPI | 1982067377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY 2329) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2025-07-08 |