| NPI | 1346810363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 013352) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 128490) |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2024-12-30 |