| NPI | 1184067860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NH 1164) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 111465) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2013-04-11 |