| NPI | 1689905531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 6720347-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW-1417) |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2022-03-15 |