| NPI | 1760853782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MA 207587) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 1557) |
| Enumeration Date | 2015-10-16 |
| Last Update Date | 2015-10-16 |