| NPI | 1457652802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089.0063533) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 54764) |
| Enumeration Date | 2010-11-16 |
| Last Update Date | 2022-02-11 |