| NPI | 1417475559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW111784) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN279561) |
| Enumeration Date | 2017-09-08 |
| Last Update Date | 2025-01-24 |