| NPI | 1760753495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 8410087-3502) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO LSW.0009921562) |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2019-12-12 |