| NPI | 1760709257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC14004) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05517600) |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2016-12-19 |