| NPI | 1144014713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW1143664) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW04419) |
| 1041C0700X Social Worker, Clinical (Licence: WV DP00946324) | |
| Enumeration Date | 2025-04-08 |
| Last Update Date | 2026-05-12 |