| NPI | 1417420282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 123453) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 224147) |
| Enumeration Date | 2019-01-04 |
| Last Update Date | 2021-06-22 |