| NPI | 1285151647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 000124882) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 224742) |
| Enumeration Date | 2017-08-26 |
| Last Update Date | 2026-01-26 |