| NPI | 1013631803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: RI ISW04380) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MA LICSW1141192) |
| Enumeration Date | 2022-09-27 |
| Last Update Date | 2025-09-04 |