| NPI | 1861272981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MA LCSW226066) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2023-10-05 |
| Last Update Date | 2023-10-05 |