| NPI | 1346316700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AZ LCSW-14109) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MA 111748) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2015-04-13 |