| NPI | 1669050662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09929139) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO LSW.0009923507) |
| 104100000X Social Worker (Licence: CO LSW.0009923507) | |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2023-04-05 |