| NPI | 1790029601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 120994) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: MA 221172) | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2018-03-17 |