| NPI | 1215965439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 104995) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2023-06-01 |