| NPI | 1861930786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 10913) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 003414) |
| Enumeration Date | 2017-02-11 |
| Last Update Date | 2020-08-28 |