| NPI | 1679608103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 034738-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 034738-1) |
| 103T00000X Psychologist (Licence: NY 034738-1) | |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2009-12-16 |