| NPI | 1750789582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 090708) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 090708) |
| Enumeration Date | 2014-12-10 |
| Last Update Date | 2015-01-29 |