| NPI | 1043799786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 093338) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NY 001671) |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2025-04-02 |