| NPI | 1871150573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW126442) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI CSW02214) |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2025-03-20 |