| NPI | 1164062220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: TN 13580) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TN 8382) |
| 1041C0700X Social Worker, Clinical (Licence: MA 125242) | |
| 1041C0700X Social Worker, Clinical (Licence: MA 224984) | |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2022-11-16 |