| NPI | 1245809730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CT 12558) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker (Licence: CT 5781) | |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2022-10-17 |