| NPI | 1215385521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 991617) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 991617) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2026-01-02 |