| NPI | 1316101215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MA 110787) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: FL SW9919) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2016-06-08 |