| NPI | 1528418456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089.0136986) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 122831) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2026-07-27 |