| NPI | 1063744894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09924303) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 079375) |
| Enumeration Date | 2010-02-04 |
| Last Update Date | 2016-08-04 |