| NPI | 1669126694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW127803) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 227565) |
| Enumeration Date | 2022-02-08 |
| Last Update Date | 2024-09-09 |