| NPI | 1952562944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MA 116117) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: RI ISW02530) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2015-06-02 |