NPI | 1114004306 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY LCSW-616) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WY PCSW-251) |
1041C0700X Social Worker, Clinical (Licence: UT 11959463-3501) | |
Enumeration Date | 2006-11-01 |
Last Update Date | 2020-10-02 |