| NPI | 1851442040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: VT 089-0001166) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NH 0719) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2011-08-23 |