| NPI | 1760036339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089.0127276) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VT 097.0091724) |
| Enumeration Date | 2019-07-31 |
| Last Update Date | 2019-07-31 |