| NPI | 1134645385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 110698) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW03092) |
| Enumeration Date | 2017-08-19 |
| Last Update Date | 2024-10-14 |