| NPI | 1417676958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 128419) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 110540) |
| Enumeration Date | 2022-08-26 |
| Last Update Date | 2024-08-14 |