| NPI | 1760449318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 004902) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CT 004902) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2013-03-26 |