| NPI | 1023767688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C017663) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA LICSW1121150) |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2025-04-22 |