| NPI | 1306165188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISW04838) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA LICSW1142725) |
| Enumeration Date | 2010-05-19 |
| Last Update Date | 2026-05-22 |