| NPI | 1871850024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904009570) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VT 089.0096303) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2018-03-17 |