| NPI | 1669871380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VT 089.0099223) |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2022-11-10 |