| NPI | 1164562773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISW03602) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS23530) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2025-05-23 |