| NPI | 1013167311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 008201) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 5149) |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2017-01-11 |