| NPI | 1053455147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY LCSW-396) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09928211) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2023-09-26 |