| NPI | 1679900765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 104100000X Social Worker (Licence: CT 2166) | |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2020-06-02 |