| NPI | 1912302670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09925854) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 219103) |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2025-09-15 |