| NPI | 1730506429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NH 2885) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 222844) |
| Enumeration Date | 2014-03-20 |
| Last Update Date | 2024-03-01 |