| NPI | 1003889486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R040844) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NY R040844) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2007-07-08 |