| NPI | 1447534896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 118164) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 217318) |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2016-07-25 |