| NPI | 1821654518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MA 121574) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 121574) |
| 1041C0700X Social Worker, Clinical (Licence: MT 42779) | |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2024-08-16 |