| NPI | 1427244243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 372600000X Adult Companion (Licence: NY 85432) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY 0704014) |
| 372600000X Adult Companion (Licence: PA PA023502Y) | |
| Enumeration Date | 2007-09-16 |
| Last Update Date | 2014-01-07 |