| NPI | 1083919922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 9090) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 313629) |
| Enumeration Date | 2011-01-25 |
| Last Update Date | 2018-06-12 |