| NPI | 1801806187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089.0089939) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC6445) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2013-05-10 |