| NPI | 1659651800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 007826) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CT 000675) |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2023-12-07 |