| NPI | 1275827586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 123199) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker (Licence: MA 223054) | |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2023-02-07 |