| NPI | 1518436237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 1177773-SW-LICSW) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 008138) |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2018-11-26 |