| NPI | 1306906706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 1650) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 07153) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2011-02-01 |