| NPI | 1134202492 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089.0001280) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2024-06-26 |