| NPI | 1609472398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09931473) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO 0009923158) |
| Enumeration Date | 2020-12-08 |
| Last Update Date | 2025-12-18 |