| NPI | 1023178605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 7949) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW02147) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2014-10-15 |