| NPI | 1720437197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 120784) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 220830) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2025-08-26 |