| NPI | 1619554995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LCSW229513) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2024-01-25 |