| NPI | 1528678653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MA LICSW126065) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 000225973) |
| Enumeration Date | 2020-08-04 |
| Last Update Date | 2023-04-01 |