| NPI | 1235575762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AK 103417) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA ISW121658) |
| 1041C0700X Social Worker, Clinical (Licence: RI isw02768) | |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2025-06-09 |