| NPI | 1073585030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 104100000X Social Worker (Licence: MA 105735) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MA 105735) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2007-07-08 |