| NPI | 1720143951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 003861) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT LADC 000190) |
| 1041C0700X Social Worker, Clinical (Licence: CT LCSW003861) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2020-01-22 |