| NPI | 1306157227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 081344) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: NY 075647-1) |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2023-04-25 |