| NPI | 1215012232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISW01214) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 1027414) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2025-07-14 |