| NPI | 1851442735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 117090) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW01300) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2012-10-11 |