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 |