| NPI | 1174042246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW09930486) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 096331-01) |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2024-11-05 |