| NPI | 1871904003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09924410) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO LSW.0009920312) |
| Enumeration Date | 2014-05-09 |
| Last Update Date | 2018-03-17 |