| NPI | 1841909645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISW04407) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 228428) |
| Enumeration Date | 2022-11-21 |
| Last Update Date | 2025-07-23 |