| NPI | 1316597826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW1130982) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA LCSW227601) |
| Enumeration Date | 2019-09-17 |
| Last Update Date | 2025-03-26 |