| NPI | 1740503671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MA 118709) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: RI ISW02467) |
| Enumeration Date | 2010-03-06 |
| Last Update Date | 2024-06-26 |