| NPI | 1558770057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL ISW10684) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 092406) |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2016-09-30 |