| NPI | 1417206194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 9923796) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CO 0009920032) |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2015-10-21 |