| NPI | 1962602094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO LCSW849) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM x-05904) |
| 1041S0200X Social Worker, School (Licence: WA LW 60643023) | |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2020-08-19 |