| NPI | 1669614434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY 1060-LCSW) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WY PCSW #342) |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2019-01-28 |