| NPI | 1093440752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 126579) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 226212) |
| Enumeration Date | 2022-07-18 |
| Last Update Date | 2023-06-30 |