| NPI | 1780235416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MA 228052) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 15623) |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2024-10-08 |