| NPI | 1124595038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA RN2390444) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 093513) |
| 1041C0700X Social Worker, Clinical (Licence: MA 125306) | |
| Enumeration Date | 2018-10-29 |
| Last Update Date | 2025-08-26 |