| NPI | 1194824011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 1027179) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 1027179) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2016-12-06 |