| NPI | 1477061547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 121673) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 6969) |
| Enumeration Date | 2018-01-11 |
| Last Update Date | 2023-04-25 |