| NPI | 1467063982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MA 126917) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2020-08-10 |
| Last Update Date | 2023-11-09 |