| 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 |