| NPI | 1487139416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 1021873-SW-LICSW) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 1021873) |
| Enumeration Date | 2018-09-25 |
| Last Update Date | 2018-09-25 |