| NPI | 1003206855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 120297) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 220459) |
| Enumeration Date | 2015-02-02 |
| Last Update Date | 2024-04-07 |