| NPI | 1619995339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 073244) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2021-02-24 |