| NPI | 1316688757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 09932145) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 17258) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2022-04-06 |
| Last Update Date | 2025-08-18 |