| NPI | 1174325583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089.0135320) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NH 5523) |
| Enumeration Date | 2025-03-26 |
| Last Update Date | 2025-06-10 |