| NPI | 1104126705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW 13134) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 082234-1) |
| Enumeration Date | 2010-10-28 |
| Last Update Date | 2016-07-10 |