| NPI | 1790047413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09928683) |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health (Licence: FL ISW5898) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2023-09-14 |