| NPI | 1740223684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WY LCSW-304) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: OR 1576) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2007-07-08 |