| NPI | 1073891834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 120187) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW03109) |
| Enumeration Date | 2011-07-28 |
| Last Update Date | 2025-04-10 |