| NPI | 1619127123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA LCSW# 0904007619) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI LICSW# 01924) |
| 1041C0700X Social Worker, Clinical (Licence: MA LICSW# 113881) | |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2024-10-27 |