| NPI | 1396395083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 876521) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO 876521) |
| 104100000X Social Worker (Licence: CO CSW876521) | |
| Enumeration Date | 2019-09-16 |
| Last Update Date | 2019-09-16 |