| NPI | 1053889402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 9814-123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09927153) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-11-04 |
| Last Update Date | 2024-04-15 |