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 |