| NPI | 1518369842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 123623) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 000223526) |
| 104100000X Social Worker | |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2021-04-27 |