| NPI | 1972836930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 041291) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| Enumeration Date | 2009-09-09 |
| Last Update Date | 2015-12-02 |