| NPI | 1144863291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.009931654) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2019-10-22 |
| Last Update Date | 2026-03-30 |