| NPI | 1760002356 |
|---|---|
| Other Name | NA NA NA |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09929528) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2020-04-23 |
| Last Update Date | 2023-08-20 |