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 |