| NPI | 1982795969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY 000107) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY 003177) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2018-04-18 |