| NPI | 1063809580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency (Licence: NY 066232) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 066232) |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2015-04-22 |