| NPI | 1326527821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 10954) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2023-08-28 |