| NPI | 1265165906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW1140665) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC26036) |
| 1041C0700X Social Worker, Clinical (Licence: CT 16120) | |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801120306) | |
| 1041C0700X Social Worker, Clinical (Licence: PA CW026277) | |
| Enumeration Date | 2022-07-08 |
| Last Update Date | 2026-07-21 |