| NPI | 1063574317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY LCSW PR000688-1) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: NY LCSW PRooo688-1) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2007-07-08 |