| NPI | 1932713914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW21476) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 109769) |
| Enumeration Date | 2020-09-07 |
| Last Update Date | 2023-05-08 |