| NPI | 1487918488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 991033) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO 991033) |
| 1041S0200X Social Worker, School (Licence: CO 991033) | |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2019-03-18 |