| NPI | 1134519317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09924456) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO LSW.0009920679) |
| Enumeration Date | 2015-01-27 |
| Last Update Date | 2026-02-11 |