| NPI | 1457410334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NH 1528) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY R043783) |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2012-08-13 |