| NPI | 1033694476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YS0200X Counselor, School |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: MA LICSW110800) |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2024-01-29 |