| NPI | 1265038061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MA 000226376) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 000226376) |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2022-03-27 |