| NPI | 1437710811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI CSW02207) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 222809) |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2019-06-26 |