| NPI | 1811569866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW1141697) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09927448) |
| Enumeration Date | 2021-07-10 |
| Last Update Date | 2025-08-12 |