| NPI | 1679607204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: RI ISW03653) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IL 149000345) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2022-12-13 |