| NPI | 1003209198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 008809) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 7912) |
| 101YP2500X Counselor, Professional (Licence: CT 005297) | |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2022-06-14 |