| NPI | 1063963403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NY 092476-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 087662-1) |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2019-06-19 |