| NPI | 1194805788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 09926719) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 067607) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2021-06-30 |