| NPI | 1124693460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MA LICSW126461) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: RI ISW03779) |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2024-11-27 |