| NPI | 1578936126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 010745) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101Y00000X Counselor (Licence: CT 3955) | |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2019-09-19 |