| NPI | 1396025268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ RLCSW-15064) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA LICSW-1025011) |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2011-08-24 |