| NPI | 1023994712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09929605) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: CO 24485746) |
| Enumeration Date | 2025-08-15 |
| Last Update Date | 2025-08-15 |