| NPI | 1184930117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CO CSW-1510) |
| Additional Taxonomies | 1041S0200X Social Worker School (Licence: CO 0473664) |
| Enumeration Date | 2010-08-27 |
| Last Update Date | 2023-10-02 |