| NPI | 1366641417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 1026428) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW01148) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2024-03-08 |