| NPI | 1609947738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 000405) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 000303) |
| 106H00000X Marriage & Family Therapist (Licence: CT 000323) | |
| Enumeration Date | 2006-11-12 |
| Last Update Date | 2008-07-29 |