| NPI | 1649347253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 114342) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 213804) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2024-04-17 |