| NPI | 1770723538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 027476) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 027476) |
| 1041C0700X Social Worker, Clinical (Licence: NY 027476) | |
| Enumeration Date | 2009-03-05 |
| Last Update Date | 2009-03-05 |