| NPI | 1972165702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISW02881) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 0121924) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2019-07-02 |