| NPI | 1326585324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW09923044) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW10452) |
| Enumeration Date | 2017-01-27 |
| Last Update Date | 2017-01-27 |