| NPI | 1215343231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISW03525) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 99467) |
| 1041C0700X Social Worker, Clinical (Licence: MA 123679) | |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2025-10-28 |