| NPI | 1063037612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09927434) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW17330) |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2024-04-01 |