| 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 |