| NPI | 1215237060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISW02118) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 116852) |
| 1041C0700X Social Worker, Clinical (Licence: CT 008437) | |
| 1041C0700X Social Worker, Clinical (Licence: NY 055803) | |
| 1041C0700X Social Worker, Clinical (Licence: FL 6180) | |
| Enumeration Date | 2010-10-27 |
| Last Update Date | 2019-01-08 |