| NPI | 1609073295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW8958) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 039309) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2009-06-29 |