| NPI | 1003193699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CT 010121) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CT 2387) |
| 104100000X Social Worker | |
| Enumeration Date | 2011-11-09 |
| Last Update Date | 2024-02-27 |