| NPI | 1720064686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY 019LCSW) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WY 019) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2008-12-11 |