| NPI | 1902928666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 072521) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NY 072521-1) |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2018-07-05 |