NPI | 1932641545 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW1130049) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical |
Enumeration Date | 2016-11-14 |
Last Update Date | 2025-08-22 |