| NPI | 1114135357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW120720) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW01795) |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2025-03-20 |