| NPI | 1720457971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 000222766) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: MA 000122563) | |
| Enumeration Date | 2015-09-17 |
| Last Update Date | 2022-07-21 |