| NPI | 1003274507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NH 2116) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 113546) |
| Enumeration Date | 2016-01-29 |
| Last Update Date | 2018-06-22 |