| NPI | 1871733204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 1028760) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: MA 347807) |
| Enumeration Date | 2009-02-25 |
| Last Update Date | 2020-10-30 |