| NPI | 1588696579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 114576) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 102951) |
| 1041C0700X Social Worker, Clinical (Licence: RI 00490) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2009-07-14 |