| NPI | 1619096898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISWO1533) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 111089) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2010-10-13 |