| NPI | 1902034622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 115715) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 213734) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2020-05-11 |