| NPI | 1790129336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 113475) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW01656) |
| 1041C0700X Social Worker, Clinical (Licence: CT 008223) | |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2014-01-20 |