| NPI | 1871082149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 11034) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 3917) |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2022-09-15 |