| NPI | 1891042206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 225514) |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2022-04-19 |