| NPI | 1700926250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 114156) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MA 51684) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2014-03-14 |