| NPI | 1902623689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MA LICSW1140602) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 227704) |
| Enumeration Date | 2024-09-24 |
| Last Update Date | 2025-08-12 |