| NPI | 1689113508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 000123321) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MA 2780) |
| 104100000X Social Worker (Licence: MA 225124) | |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2023-09-08 |