| NPI | 1578697900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 058540) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 058540) |
| 106H00000X Marriage & Family Therapist (Licence: NY 058540) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2007-07-08 |