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 |