| NPI | 1114576345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 122367) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW03912) |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2024-01-02 |