| NPI | 1356492102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09926593) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 21907) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2021-12-08 |