| NPI | 1972639185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI 02645) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 27876) |
| Enumeration Date | 2007-02-24 |
| Last Update Date | 2016-10-07 |