| NPI | 1861879363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 124371) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker (Licence: MA 225320) | |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2022-06-08 |