| NPI | 1477824266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 2688) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 18) |
| 106H00000X Marriage & Family Therapist (Licence: CT 583) | |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2017-02-22 |