| NPI | 1487749800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 100552) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 10052) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-05-27 |