| NPI | 1619600939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 126617) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NH 5157) |
| 1041C0700X Social Worker, Clinical (Licence: ME LC24947) | |
| 1041C0700X Social Worker, Clinical (Licence: MA 1121354) | |
| Enumeration Date | 2022-07-05 |
| Last Update Date | 2026-03-31 |