| NPI | 1013158914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 080639) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 72078317) |
| Enumeration Date | 2009-03-23 |
| Last Update Date | 2014-04-30 |