| NPI | 1184659039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: VT 089.0001039) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| 1041C0700X Social Worker Clinical (Licence: MA 111321) | |
| 1041C0700X Social Worker Clinical (Licence: NH EL07134) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2021-10-21 |