| NPI | 1053947028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISW03070) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 93042) |
| Enumeration Date | 2020-03-21 |
| Last Update Date | 2023-11-27 |