| NPI | 1629169875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 114552) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW01743) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2016-05-27 |