| NPI | 1114164738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISW00142) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA CSW007175) |
| Enumeration Date | 2009-01-20 |
| Last Update Date | 2020-10-22 |