| NPI | 1114979986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI isw01394) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 1024584) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2007-11-09 |