| NPI | 1407203524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MA 128421) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MA 227488) |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2024-09-25 |