| NPI | 1952876476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ICSW3890) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 127917-121) |
| Enumeration Date | 2018-10-11 |
| Last Update Date | 2025-05-28 |