| NPI | 1265578058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 105311) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW00819) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2023-08-15 |