| NPI | 1053489732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NH 107) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 106093) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2008-04-02 |