| NPI | 1831642990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 124656) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW03527) |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2026-04-09 |