| NPI | 1417573536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO csw.09927518) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 098297) |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2025-12-29 |