| NPI | 1598248098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09929057) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM X-10749) |
| 1041C0700X Social Worker, Clinical (Licence: NM M-10595) | |
| 1041C0700X Social Worker, Clinical (Licence: TX 104761) | |
| Enumeration Date | 2018-09-11 |
| Last Update Date | 2023-07-24 |