| NPI | 1316474844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089.0134364) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 096414) |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SCO4556500) | |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2024-02-28 |