| NPI | 1285008391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CO CSW.09923904) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CO 0009920176) |
| 1041C0700X Social Worker Clinical (Licence: MO 2015019167) | |
| 1041C0700X Social Worker Clinical | |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2021-06-17 |