| NPI | 1124247556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09926304) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149009582) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2019-12-05 |