| NPI | 1083683338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY RO36366-1) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NY Pending) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2017-01-17 |