| NPI | 1215261243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW12757) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 080628) |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2015-10-28 |