| NPI | 1861154635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 125806) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 225106) |
| Enumeration Date | 2021-10-09 |
| Last Update Date | 2022-12-06 |