| NPI | 1982136537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CT 16274) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 1463) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2026-04-22 |