| NPI | 1326143991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089.0134347) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 0047871) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2021-04-05 |