| NPI | 1194018051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 120293) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L7108) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2024-11-23 |