| NPI | 1346656071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW09923408) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM SWB-2023-1240) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2023-12-06 |