| NPI | 1366792798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09926381) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO CSW.09926381) |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2024-05-29 |