| NPI | 1457167769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 012916) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VT 089.0136543TELE) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 001419) | |
| Enumeration Date | 2024-12-10 |
| Last Update Date | 2025-10-03 |