| NPI | 1982113619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09926227) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO 0009921493) |
| Enumeration Date | 2017-09-26 |
| Last Update Date | 2019-10-07 |