| NPI | 1245968460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 09928319) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 107484) |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2022-08-15 |