| NPI | 1679644918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251300000X Local Education Agency (LEA) |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services (Licence: NY 005888) |
| 101YM0800X Counselor, Mental Health (Licence: NY 005888) | |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2014-01-14 |