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 |