| NPI | 1770094302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI CSW03557) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CSW03557) |
| Enumeration Date | 2017-10-23 |
| Last Update Date | 2025-09-02 |