| NPI | 1750111662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 1120265) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 228420) |
| Enumeration Date | 2024-08-05 |
| Last Update Date | 2025-07-23 |