| NPI | 1194816884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ID LCSW-35629) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MA 110763) |
| 1041C0700X Social Worker Clinical (Licence: VT 089 0092617) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2023-10-04 |