| NPI | 1073814661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NH 1499) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 107876) |
| Enumeration Date | 2010-11-12 |
| Last Update Date | 2012-04-05 |