| NPI | 1275960478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 117822) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: MA 117822) |
| Enumeration Date | 2013-10-02 |
| Last Update Date | 2021-05-30 |