| NPI | 1992230320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW126562) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW023531) |
| 1041C0700X Social Worker, Clinical (Licence: OH I.2304384) | |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2023-10-30 |