| NPI | 1225407810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C014520) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VT 089-0113299) |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2023-07-11 |