| NPI | 1972919454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 120205) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 219869) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2018-07-30 |