| NPI | 1356087829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 125100) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 225478) |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2022-06-14 |