| NPI | 1336201151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY R0241711) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 1041S0200X Social Worker School | |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2007-07-26 |