| NPI | 1750783163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 09923511) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO 1159) |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2020-11-23 |