| NPI | 1902206345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 220115) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 092383) |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2014-09-05 |