| NPI | 1255229423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW1142463) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CT 8564) |
| Enumeration Date | 2025-06-26 |
| Last Update Date | 2025-11-10 |