NPI | 1518294867 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089.0000122) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 5571) |
Enumeration Date | 2009-11-06 |
Last Update Date | 2009-12-07 |