| NPI | 1013211663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R036920-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL PSW800) |
| Enumeration Date | 2010-12-22 |
| Last Update Date | 2022-07-21 |