| NPI | 1013344423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 119649) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 219193) |
| Enumeration Date | 2013-09-30 |
| Last Update Date | 2023-08-20 |