| NPI | 1730447152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY LCSW-956) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WY PCSW-554) |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2015-10-09 |