| NPI | 1386714640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 1015836) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 003129) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2021-02-01 |