| NPI | 1700614914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CT 14190) |
| Additional Taxonomies | 1041S0200X Social Worker School (Licence: CT 14190) |
| Enumeration Date | 2024-07-22 |
| Last Update Date | 2024-07-22 |