| NPI | 1821711573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISW03728) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 125911) |
| Enumeration Date | 2022-09-19 |
| Last Update Date | 2023-04-19 |