NPI | 1134767437 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 123358) |
Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: MA 223187) |
Enumeration Date | 2019-12-17 |
Last Update Date | 2024-06-12 |