| NPI | 1396075677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904008411) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW02218) |
| Enumeration Date | 2010-01-08 |
| Last Update Date | 2016-03-15 |