| NPI | 1477886976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089-0120996) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 079624-1) |
| Enumeration Date | 2009-09-15 |
| Last Update Date | 2016-07-21 |