| NPI | 1972676211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 114923) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 213065) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2009-09-18 |