| NPI | 1871893891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC12521) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA LC115879) |
| Enumeration Date | 2010-10-25 |
| Last Update Date | 2010-10-25 |