| NPI | 1023751211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09929734) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO LSW.0009923639) |
| Enumeration Date | 2022-04-15 |
| Last Update Date | 2025-03-03 |