| NPI | 1376641340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NH 43) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 105277) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2021-04-01 |