| NPI | 1841202207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 107497) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW00362) |
| 106H00000X Marriage & Family Therapist (Licence: RI MFT00002) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2007-07-08 |