| NPI | 1215004320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 102219) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NH 4) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2007-07-08 |