| NPI | 1508901497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 5330) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CT 000655) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2017-03-15 |