| NPI | 1023574472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MA 122804) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 210367) |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2021-06-29 |