| NPI | 1629357082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY LCSW-807) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WY PCSW-348) |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2020-02-27 |