| NPI | 1225167984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: VT 089-0001010) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MA 1024625) |
| 1041C0700X Social Worker Clinical (Licence: WI 04-PE-AOOOAJ9) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2007-07-09 |