Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003581893 |
---|---|
Provider Name | Seth Gozar |
First Address | Jacksonville, FL 32224-8623 |
Second Address | Jacksonville, FL 32207-3691 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2021 |
Last Update Date | 12/08/2021 |