| NPI | 1538455761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 117433) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 216088) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2015-07-01 |