| NPI | 1700386745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY PCSW-1031) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WY CSW-284) |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2023-11-22 |