| NPI | 1114078557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISW00775) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 107591) |
| Enumeration Date | 2007-01-14 |
| Last Update Date | 2007-07-08 |