| NPI | 1124747365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI isw04354) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI CSW02751) |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2025-02-19 |