| NPI | 1720068521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: RI ISW01562) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MA MA LR 110751) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2007-07-08 |