| NPI | 1225566870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 09926601) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2022-05-17 |