| NPI | 1700230927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 122798) |
| Additional Taxonomies | 101Y00000X Counselor |
| 1041C0700X Social Worker, Clinical (Licence: MA 223204) | |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2022-01-27 |