| NPI | 1417914995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 73-071302) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW18382) |
| 1041C0700X Social Worker, Clinical (Licence: CA LCSW112997) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2023-03-27 |