| NPI | 1154608982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 214539) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 16564) |
| Enumeration Date | 2011-11-08 |
| Last Update Date | 2011-11-08 |