| NPI | 1669672341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MA 120714) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CT 003907) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2021-01-29 |