| NPI | 1194406058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09932298) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO LSW.0009925157) |
| Enumeration Date | 2023-07-25 |
| Last Update Date | 2025-09-17 |