| NPI | 1871163634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09930225) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2025-09-10 |