| NPI | 1083747752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 1022091) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 1022091) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2015-03-03 |