| NPI | 1124679261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089.0134506) |
| Additional Taxonomies | 104100000X Social Worker (Licence: VT 156-0133878) |
| Enumeration Date | 2019-09-20 |
| Last Update Date | 2022-05-10 |