| NPI | 1649830746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 09929313) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 106475-01) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2023-09-19 |