| NPI | 1396982369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NH 1443) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 111604) |
| Enumeration Date | 2009-01-13 |
| Last Update Date | 2016-12-12 |