| NPI | 1225429194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 005443) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 113787) |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2015-02-12 |