| NPI | 1013771260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 0890136275) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2024-02-08 |
| Last Update Date | 2025-12-05 |