| NPI | 1942180849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09930798) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL TPSW6344) |
| Enumeration Date | 2025-09-03 |
| Last Update Date | 2026-03-18 |