| NPI | 1598817942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT LCSW 000 2029) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL 8797) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2014-08-08 |