| NPI | 1306100367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 8820) |
| Additional Taxonomies | 104100000X Social Worker |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2026-08-19 |