| NPI | 1396344453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 000226082) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| Enumeration Date | 2020-10-20 |
| Last Update Date | 2020-10-20 |