| NPI | 1063211670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CO SWC.0000002300) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CO LSW.0009925760) |
| Enumeration Date | 2025-03-08 |
| Last Update Date | 2025-03-11 |