| NPI | 1326376104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 006619) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 000589) |
| 1041C0700X Social Worker, Clinical (Licence: GU LCSWE-006) | |
| Enumeration Date | 2009-12-06 |
| Last Update Date | 2024-08-18 |