| NPI | 1508222951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC20435) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VT 089-0111091) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 151-0125023) | |
| Enumeration Date | 2016-01-14 |
| Last Update Date | 2021-12-10 |