| NPI | 1891437893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI CSW03213) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 000227826) |
| Enumeration Date | 2022-04-11 |
| Last Update Date | 2023-06-12 |