| NPI | 1891165361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 225980) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 042160528) |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2022-11-26 |