| NPI | 1184165722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 58.013004) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C004527) |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2024-10-23 |