| NPI | 1700979663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW12463) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R054471-1) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2015-07-14 |