| NPI | 1336355395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 0735881-1) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NY 0735881-1) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2007-10-17 |