| NPI | 1801029434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09925777) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904008418) | |
| Enumeration Date | 2009-08-31 |
| Last Update Date | 2021-09-21 |