| NPI | 1295574960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO SWC.0000002508) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2024-05-22 |
| Last Update Date | 2025-06-23 |