| NPI | 1780980144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW13541) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 084817-1) |
| Enumeration Date | 2011-02-02 |
| Last Update Date | 2025-01-15 |