| NPI | 1003917857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089-0001151) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 113601) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2012-07-25 |