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 EL33149) |
Enumeration Date | 2011-11-29 |
Last Update Date | 2025-10-07 |