| NPI | 1770644312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 071648) |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: NY 071648-1) |
| 101YM0800X Counselor, Mental Health (Licence: NY 071648) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2011-04-20 |