| NPI | 1083850440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY LCSW-691) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: WY LAT-356) |
| Enumeration Date | 2009-01-06 |
| Last Update Date | 2021-11-12 |