| NPI | 1780135012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 010639) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CT 000393) |
| 104100000X Social Worker (Licence: CT 010639) | |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2019-12-18 |