| NPI | 1861936064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 00991917) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.00991917) |
| Enumeration Date | 2016-12-07 |
| Last Update Date | 2022-02-10 |