| NPI | 1821058702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISW01717) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 104905) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2015-12-04 |