| NPI | 1336353630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 066252-1) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA LICSW127150) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2025-05-01 |