| NPI | 1285182212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 09926509) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO 0009921839) |
| Enumeration Date | 2016-09-20 |
| Last Update Date | 2021-06-22 |