| NPI | 1457409203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY R035065) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY R035065-1) |
| 106H00000X Marriage & Family Therapist (Licence: NY 000293-1) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2010-05-21 |