| NPI | 1619968716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW14596) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R02529-1) |
| Enumeration Date | 2005-10-30 |
| Last Update Date | 2018-06-20 |