| NPI | 1902982614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 115818) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 4971402-3502) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2011-01-06 |