| NPI | 1154427938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY LCSW-085) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA LCSW-085) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2022-04-11 |