| NPI | 1629189824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC10413) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW 001208 L) |
| 1041C0700X Social Worker, Clinical (Licence: NJ SC-02716) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-08 |