| NPI | 1336272558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY RO21140) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY RO21140) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2013-09-24 |