| NPI | 1972037810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 122698) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 222252) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2020-05-15 |