| NPI | 1245573690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 117436) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VT 089.0066223) |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2013-04-04 |