| NPI | 1992002869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: MA 103441) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 103441) |
| Enumeration Date | 2011-02-11 |
| Last Update Date | 2013-01-04 |