| NPI | 1831347558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MA 118604) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: MA 15959225) |
| Enumeration Date | 2008-09-06 |
| Last Update Date | 2024-03-28 |