| NPI | 1821265901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R054181-1) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY R054181-1) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2011-08-24 |