| NPI | 1730756446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA LCSW226447) |
| Enumeration Date | 2021-06-10 |
| Last Update Date | 2024-10-24 |