| NPI | 1225813819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO SWC.0000001567) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2023-08-30 |
| Last Update Date | 2024-09-11 |