| NPI | 1396165650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY LCSW-1264) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 1041C0700X Social Worker, Clinical (Licence: WY PCSW-743) | |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2020-07-20 |