| NPI | 1255451860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 100144) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW01363) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2007-07-08 |