| NPI | 1245356732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: RI TSW00186) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MA 103488) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2011-01-13 |