| NPI | 1336576065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW1142209) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA LCSW229013) |
| Enumeration Date | 2013-09-26 |
| Last Update Date | 2026-09-16 |