| NPI | 1841015880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: RI CSW03948) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 119058-01) |
| Enumeration Date | 2024-11-15 |
| Last Update Date | 2024-11-15 |