| NPI | 1841517992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISW02275) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 215001) |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2013-01-07 |