| NPI | 1376290593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MA LICSW128226) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 226906) |
| Enumeration Date | 2022-03-08 |
| Last Update Date | 2024-07-26 |