| NPI | 1083029052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 119401) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 219242) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2024-02-22 |