| NPI | 1609215201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09925006) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 76517) |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2023-08-07 |