| NPI | 1003367319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089.0122958) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW11876) |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2017-09-26 |