| NPI | 1184241671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 126552) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 000225892) |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2024-07-17 |