| NPI | 1740615905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 219221) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 119358) |
| Enumeration Date | 2013-09-06 |
| Last Update Date | 2016-09-14 |