| NPI | 1396092060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 121958) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 003428) |
| Enumeration Date | 2012-08-12 |
| Last Update Date | 2019-08-16 |