| NPI | 1104295344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09929397) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 090921) |
| Enumeration Date | 2015-09-17 |
| Last Update Date | 2023-08-10 |