| NPI | 1255709176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 123328) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 000221897) |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2025-03-20 |