| 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 |