| NPI | 1407903685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 114115) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 210198) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2014-12-30 |