| NPI | 1285259010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09928919) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO NLC.0006396) |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2023-01-12 |