| NPI | 1720164106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISW02936) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC7767) |
| Enumeration Date | 2006-10-28 |
| Last Update Date | 2019-10-04 |