| NPI | 1346651700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW125433) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ 12294) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2023-05-16 |