| NPI | 1386189793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW1120547) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA csw005908) |
| Enumeration Date | 2016-12-21 |
| Last Update Date | 2025-01-28 |