| NPI | 1245329838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 085469) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NY 068800) |
| 1041C0700X Social Worker, Clinical (Licence: VT 089.0134169) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2019-03-19 |