| NPI | 1912524232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NH 2627) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI CSW02488) |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2023-01-11 |