| NPI | 1104332139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09926834) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO LSW.0009921852) |
| Enumeration Date | 2017-12-28 |
| Last Update Date | 2021-01-12 |