| NPI | 1467551325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW-09923201) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MT LCSW-857) |
| 1041C0700X Social Worker, Clinical (Licence: WY LCSW-638) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2013-04-19 |