| NPI | 1306320189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MA 126124) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 226146) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-09-18 |
| Last Update Date | 2025-03-10 |