| NPI | 1568023489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 123675) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 224111) |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2024-11-22 |