| NPI | 1558767988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09925568) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2024-04-01 |