| NPI | 1386742385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY r23782) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY r23782) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2011-02-28 |