| NPI | 1588688667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CO CSW.00001426) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 34609) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2022-02-24 |