| NPI | 1730973744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 126840) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI CSW03939) |
| Enumeration Date | 2025-04-07 |
| Last Update Date | 2025-04-07 |