| NPI | 1548443229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 25449) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 115532) |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2012-08-02 |