| NPI | 1104995018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY R0415881) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY R0415881) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2010-02-09 |