| NPI | 1942709944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 099226548) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO 0009921896) |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2020-03-12 |