| NPI | 1750699351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089.0084088) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VT 08900084088) |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2024-02-13 |