| NPI | 1780872101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089.0110298) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 121879) |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2019-06-24 |