| NPI | 1538416086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09924914) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM C-09466) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2018-04-05 |