| NPI | 1790831584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09927989) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 16736) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2024-02-23 |