| NPI | 1982722062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 006800) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC043926) |
| 1041C0700X Social Worker, Clinical (Licence: ME LC13228) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2013-02-07 |