| NPI | 1558813501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 125747) |
| Additional Taxonomies | 104100000X Social Worker |
| 104100000X Social Worker | |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2023-04-27 |