| NPI | 1750776191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI CSW01673) |
| Additional Taxonomies | 225A00000X Music Therapist (Licence: CBMT#06687) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2015-04-02 |