| NPI | 1295874683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 1016656) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW02417) |
| 1041C0700X Social Worker, Clinical (Licence: ME LC25131) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2026-02-10 |