| NPI | 1184220311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CO 09929100) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO 0009923239) |
| Enumeration Date | 2020-12-11 |
| Last Update Date | 2023-08-10 |