| NPI | 1891352761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09928510) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO LSW.0009922956) |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2022-08-16 |