| NPI | 1720355266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 126075) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NH 2561) |
| Enumeration Date | 2011-11-29 |
| Last Update Date | 2023-10-02 |