NPI | 1972789345 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089.0074343) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR 4064) |
Enumeration Date | 2008-01-16 |
Last Update Date | 2011-01-20 |