| NPI | 1063985547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 11331) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CT 4645) |
| 1041C0700X Social Worker, Clinical (Licence: CT 58.011331) | |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2024-01-22 |