| NPI | 1003485897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY LCSW-1584) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 105135) |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2024-03-21 |