| NPI | 1205846540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: VT 089-0000380) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VT 089-0000380) |
| 1041C0700X Social Worker, Clinical (Licence: VT 089-0000380) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2008-08-04 |