| NPI | 1528507076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: VT 089.0134266) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 3830) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2025-09-04 |