| NPI | 1912339185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 1912339185) |
| Enumeration Date | 2013-07-30 |
| Last Update Date | 2022-03-21 |