| NPI | 1578773412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NH 1576) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MA 115363) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2021-08-26 |