| NPI | 1932477494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NY 13-4182492) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 058031-1) |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2011-12-15 |