| NPI | 1295791333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.00991066) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WY LCSW 158) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2019-12-09 |