| NPI | 1609259571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISW02794) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH 1500690) |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2024-02-12 |