| NPI | 1831722123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 000124176) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 089381) |
| Enumeration Date | 2020-02-15 |
| Last Update Date | 2021-10-22 |