| NPI | 1013116193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO LCSW - 992649) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2018-11-08 |