| NPI | 1497158984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 121794) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 222138) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2020-02-19 |