| NPI | 1790903417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW13703) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R-069776) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2022-07-21 |