| NPI | 1104254515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: VT 089.0000242) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NH 1112) |
| Enumeration Date | 2013-10-22 |
| Last Update Date | 2013-10-22 |