NPI | 1174703631 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 113951) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NH 1248) |
Enumeration Date | 2007-11-13 |
Last Update Date | 2017-03-27 |