| NPI | 1902481146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 105524) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI CSW02139) |
| Enumeration Date | 2021-03-09 |
| Last Update Date | 2024-10-02 |