| NPI | 1265614416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW 11703) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 073838) |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2014-03-26 |