| NPI | 1013287168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: VT 089.0134372) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: UT 9539574-3501) |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2023-06-22 |