NPI | 1750498648 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC19474) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VT 0890000910) |
Enumeration Date | 2006-08-24 |
Last Update Date | 2020-11-20 |