| NPI | 1508148248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW 116618) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW01531) |
| Enumeration Date | 2011-09-19 |
| Last Update Date | 2025-10-29 |