| NPI | 1033778709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 123232) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 222008) |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2023-08-11 |