| NPI | 1649054347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI CSW03076) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0903003792) |
| Enumeration Date | 2023-08-23 |
| Last Update Date | 2023-08-23 |