| 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 |