| NPI | 1154672848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NY 001043-1) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: NY 001043-1) |
| Enumeration Date | 2012-09-21 |
| Last Update Date | 2012-09-21 |