| NPI | 1578952271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 12812) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 082779) |
| Enumeration Date | 2015-01-19 |
| Last Update Date | 2020-10-24 |