| NPI | 1326191933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089.0134474) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 25741) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2024-01-06 |