| NPI | 1659780757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09924246) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.015011) |
| 1041C0700X Social Worker, Clinical (Licence: IL 149017319) | |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2023-02-01 |