| NPI | 1053660803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089-0001204) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NH 2211) |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2019-04-25 |