| NPI | 1518048313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW10762) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 073720-1) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2012-11-15 |