| NPI | 1497817860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NH 1028) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MA 11627) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2007-07-08 |