| NPI | 1578920518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09927125) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WY LCSW-1315) |
| Enumeration Date | 2016-01-21 |
| Last Update Date | 2024-07-22 |