| NPI | 1154091015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW1141446) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2025-08-11 |