| NPI | 1174675425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW00984016) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO 984016) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2019-08-21 |