| NPI | 1508145608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NE PLMHP 8681) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NE PLADC P-829) |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2011-08-08 |