| NPI | 1427571298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 16560) |
| Additional Taxonomies | 104100000X Social Worker |
| 101Y00000X Counselor | |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2026-03-27 |