| NPI | 1174569115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NH 1654) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 1025795) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2013-08-16 |