| NPI | 1366119976 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW1120190) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 228374) |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2024-11-12 |