NPI | 1295137453 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 1041C0700X) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC14948) |
Enumeration Date | 2014-09-19 |
Last Update Date | 2025-02-12 |