| NPI | 1245553726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 122890) |
| Enumeration Date | 2010-03-11 |
| Last Update Date | 2022-01-19 |