| NPI | 1518149095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 7029) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI CSW01110) |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2017-03-18 |