| NPI | 1831892520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089.0136535) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VT 097.0136134) |
| 104100000X Social Worker (Licence: VT 156.0134175) | |
| 104100000X Social Worker (Licence: NY 113468) | |
| 1041C0700X Social Worker, Clinical (Licence: NY 099963) | |
| Enumeration Date | 2023-03-23 |
| Last Update Date | 2025-05-30 |