| NPI | 1366644395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI CSW02934) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA none) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2025-08-01 |