| NPI | 1932598679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 09924241) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO 0009920308) |
| Enumeration Date | 2015-01-19 |
| Last Update Date | 2025-12-17 |