| NPI | 1578552626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 005437) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 110572) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2007-07-08 |