| NPI | 1386662997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 114117) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 004967) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2007-12-18 |