| NPI | 1972026946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CO 09924006) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| 171M00000X Case Manager/Care Coordinator (Licence: CO 09924006) | |
| Enumeration Date | 2017-07-21 |
| Last Update Date | 2023-09-06 |