| NPI | 1215627781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 09927690) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL 14197) |
| Enumeration Date | 2023-05-09 |
| Last Update Date | 2023-05-09 |