| NPI | 1285068478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW121443) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 221287) |
| Enumeration Date | 2013-08-24 |
| Last Update Date | 2024-10-22 |