| NPI | 1568002228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW1121478) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2020-01-10 |
| Last Update Date | 2025-11-14 |