| NPI | 1679710461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CO CSW-1898) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: KY 1177) |
| Enumeration Date | 2009-01-15 |
| Last Update Date | 2020-05-11 |