| NPI | 1396522868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 230766) |
| Enumeration Date | 2023-09-11 |
| Last Update Date | 2024-09-16 |