| NPI | 1821572843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 122931) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 223665) |
| Enumeration Date | 2018-09-17 |
| Last Update Date | 2022-07-07 |