| NPI | 1801197736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 118114) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2010-11-09 |
| Last Update Date | 2022-02-10 |