| NPI | 1164653150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 025100) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 025100) |
| 102L00000X Psychoanalyst (Licence: NY 025100) | |
| 106H00000X Marriage & Family Therapist (Licence: NY 025100) | |
| 171M00000X Case Manager/Care Coordinator (Licence: NY 025100) | |
| Enumeration Date | 2009-08-07 |
| Last Update Date | 2009-08-07 |