| NPI | 1053890897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CO CSW.09926713) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2020-07-15 |