| NPI | 1942325097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY PR007147-1) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY PR0071471) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2014-11-06 |