| NPI | 1891297560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI CSW04388) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW115602) |
| Enumeration Date | 2018-03-08 |
| Last Update Date | 2025-12-10 |