| NPI | 1538762471 |
|---|---|
| Former Name | COLT GORDON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 110973) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WY 1577) |
| Enumeration Date | 2020-11-20 |
| Last Update Date | 2024-01-31 |