| NPI | 1528380359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW11119) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 066859) |
| Enumeration Date | 2010-02-21 |
| Last Update Date | 2023-08-16 |