| NPI | 1487962940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 118831) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 013245) |
| Enumeration Date | 2010-09-18 |
| Last Update Date | 2025-04-18 |