| NPI | 1427281849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 118535) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker (Licence: SC 9753) | |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2016-04-21 |