| NPI | 1285363366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISW04644) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA LICSW1140841) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2026-02-09 |