| NPI | 1104869973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 23841) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NH 1132) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2019-10-14 |