| NPI | 1497955009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW 35511) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WY LCSW 744) |
| Enumeration Date | 2007-07-21 |
| Last Update Date | 2016-07-05 |