| NPI | 1619293735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NH 1852) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 113434) |
| Enumeration Date | 2010-04-14 |
| Last Update Date | 2019-08-08 |