| NPI | 1538334503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 215938) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 23682) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2011-08-10 |