| NPI | 1386324804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 228036) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 6411) |
| Enumeration Date | 2023-07-19 |
| Last Update Date | 2023-07-19 |