| NPI | 1760517510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 110450) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW01370) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2009-02-09 |