| NPI | 1881560787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089.0136522) |
| Additional Taxonomies | 104100000X Social Worker (Licence: VT 089.0136552) |
| Enumeration Date | 2025-10-16 |
| Last Update Date | 2026-07-16 |